UTI Treatment Guidelines - Rochester Patient Safety
[Pages:43]UTI Treatment Guidelines
Eric Myers, Pharm.D. PGY-2 Infectious Diseases Pharmacy Resident
Objectives
Evaluate the rationale for new guidelines for the treatment of UTI in long term care Design a treatment regimen for empiric and targeted therapy of UTIs using the new guidelines
2
Rationale for UTI Guideline
1. Improve treatment of UTIs ? Increase likelihood that empiric therapy covers most common causative organisms
2. Reduce incidence of antimicrobial-related adverse events (C. diff) ? Prevent unnecessary prescription of antibiotics ? Reduce prescription of high risk antibiotics (quinolones, 3rd generation cephalosporins)
3
Adverse Effects of Fluoroquinolones
GI toxicity CNS toxicity (weakness, confusion, delirium, seizures) QTc prolongation Tendon rupture Clostridium difficile-associated diarrhea Hypo-/hyperglycemia
Increased risk and/or severity in elderly patients
4
Owens Jr. RC et al. Clin Infect Dis 2005;41:S144-57
C. Diff and the Elderly
1600
2013 CDI Incidence by Age Group
Incidence (per 100,000 population)
1400
1200
1000
800
600
400
200
0 1-17
18-39
Rochester Emerging Infection Program surveillance data
40-49
50-59
Age Groups
60-69
70-84
85+ 5
Risk of C. diff Infection (CDI) by Antibiotic Class
Retrospective study ? 7,792 patients and 241 cases of CDI ? Risk of CDI compared between antimicrobial classes
6
Stevens V et al. Clin Infect Dis 2011;53:42-8
When to Give Antibiotics: Uncatheterized Patients
Positive urine
culture
Symptom criteria
? 105 cfu/mL
? Acute dysuria --OR-? Fever + 1 of following (new or
worsening from baseline): ? Urinary urgency ? Frequency ? Suprapubic pain ? Gross hematuria ? Costovertebral angle tenderness ? Urinary incontinence
**New onset delirium is NOT a symptomatic criterion** 7
Loeb M et al. Infect Control Hosp Epidemiol 2001;22:120-4
When to Give Antibiotics: Indwelling Catheter
Positive urine
culture
? 105 cfu/mL
Symptom criteria
? At least 1 of following (new or worsening from baseline):
? Fever ? New costovertebral tenderness ? Rigors
? New onset delirium not attributable to another cause
8
Loeb M et al. Infect Control Hosp Epidemiol 2001;22:120-4
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